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You Give Me Fever [and then you take it away?]

Question for those with a finer understanding of the human body: if fever is a self-defense mechanism that helps the body kill off invaders through heat, why do we take medications to lower fever when we’re sick? Isn’t that self-defeating?

Comments

Lisa Howard on February 7, 2005 - 21:20

Sometimes the body doesn’t ‘know’ what is good for it. Our bodies can actually kill us with their self defense mechanisms. If the body gets too hot (which it does to protect us from pathogens), we cook a little and die. Allergies are another example of our body not knowing what is good for us. Allergies are one’s own body fighting a perceived invader (pollen or dust mite dung) using weapons that can kill it. The body’s immune system attacks the invader but in the process kills itself. See Anaphylactic shock.

We’re in an evolutionary arms race with our microbial predators and parasites, so if you look at how our species lineage is doing at any given time point—such as the period we’re in now—you’re bound to find our defense mechanisms skirting the edge of what’s practicable or even having momentarily lost the advantage. Instead of griping about our current defense systems, I’d recommend you just be glad we’re not extinct. Actually, I take that back, because thinking and even neuroses count as part of our biological defense system. So you can resume evolving and never mind what I said.

I just realized none of us has taken on your question explicitly. I don’t know the answer and I’m not sure I even fully understand the premise. In particular, I’m not sure a physician would medicate against a fever without simultaneously medicating against whatever pathogen or circumstance to which your body is responding with a fecer. Would they? I don’t even know what meds combat fever or how they do it. Anybody? (Aspirin? Ice cubes?) I don’t know what you’d want to do while waiting in the bush for a helicopter to evacuate you and a companion who you’ve diagnosed with a potentially lethal rapidly progressing microbial infection and a 105 degree fever and you have no antimicrobials but do have something that could entirely eliminate the fever. Probably you’d use it, because being 105 by itself is deadly. Maybe if your companion were only at 103 you wouldn’t want to do anything though, because maybe the fever would retard progression of the infection (would it really?). Meanwhile, since I suspect you might have wee Oliver in mind as you ask this,I’ll mention that it occurs to me the treatment strategy might be different for children and their perhaps more easily poached developing brains.

Actually, several different medical systems would present an approach that tried to allow a fever to do it’s work while managing it. For example, here is how homeopathy sees fever http://www.hpathy.com/papersne…. Traditional Chinese Medicine (TCM) takes a highly refined diagnostic approach to fever defining it in so many forms that treatment becomes aligned with several symptoms not exclusively the fever. TCM also has defined limits for low and high fever much like our Western version.

Looks like the fevers associated with many conditions in fact aren’t treated. I guess this doesn’t imply a fever does any good, only that it doesn’t doesn’t do harm.

“Fevers under 101 degrees Fahrenheit (38.3 degrees Celsius) generally do not need to be treated unless your child is uncomfortable or has a history of febrile convulsions. Even higher temperatures are not in themselves dangerous or significant unless your child has a history of convulsions or a chronic disease. “http://www.medem.com/MedLB/art…

Let’s reframe: it’s 11:00 p.m. on a Sunday night. Your child has had a fever of 103 degrees F for several hours. Do you (a) try to “bring the fever down” with Children’s Tylenol, (b) take the child to the emergency room or (c) give him plenty of fluids, make sure he gets lots of rest, and wait until the fever passes. Of course there are all sorts of “take action X if he also symptom Y” provisos that must be attached to any answer, like “if he’s also convulsing” or “if he’s also throwing up violently.”

My question is simply is fever a “bad” thing that needs to always be “brought down?” This seems to be the conventional wisdom. Or at least the conventional wisdom in our family. And I’m wondering if we are doing the right thing.

As a side note, let me sing the evils of the various “family medical guides” that one can obtain. They inevitably contain complicated “diagnostic flow charts” wherein the parent answers a series of questions — “does you child have a fever?” or “are there blotches on their face? — and depending on the answer, one takes a branch that might lead to “get your child to the emergency room right away” or “your child is okay.” The problem with these charts is that there are a lot of branches that lead to things that sound very dire and deadly, and when the difference between “okay” and “he has the plague” is a subtle interpretation of “rash/no rash” or “is she irritable?” it’s hard not to jump in the car, or at least panic a lot.

Maybe this is what parenthood is — a long series of diagnoses interspersed with periods of fitful sleep.

Boolean logic ain’t gonna help in that situation Peter.Go see the doctor, Mr. Spock!Don’t overthink it.Jump in the car, don’t hesitate because you are going to waste enough time just parking at QEH. If you think you need to go, then err on the side of caution and go.What do you have to lose?

Go, have periods of fitful sleep in the waiting room.

When you come to the point of debating ‘should I go to the hospital’, don’t torture yourself with logic man — just go.

But Ken, what about (a) the cost to the healthcare system of everyone kneejerk jumping in the car at sign of fever and (b) the possible dangers of additional maladies to be had, by Oliver or by Catherine and I, in the emergency waiting room?

Based on the pediatric reference I quoted, a fever of 101 is not a “bad” thing that needs to always be “brought down”. For 103 I wouldn’t be surprised if you heard different answers from different doctors, but I have no idea.

(BTW your human-test is caps-sensitive. I just got blocked for not remembering Chile’s capital)

Let a doctor do the diagnosis rather than you sweating over a diagnostic flow chart. I want you to jump in the car past the point of knee-jerk, but this side of convulsions. Late diagnosis cost more to me the taxpayer, and you the injured or bereaved.

Now, to the dangers of the waiting room. This indicates you are afraid of hospitals which is irrational. Illogical!

Anyway, too many people deny themselves healthcare with mindsets like yours and suffer for it. If you paid for your healthcare privately would you be more inclined to use it when Oliver is sick?

Guilty patients — uniquely Canadian!

After two visits to emergency rooms which revealed nothing serious (one at the American Hospital in Paris, the other in Indianapolis) both doctors promptly ran some tests and were very comforting and reassured us we were wise to have come to them.These experiences have cured me of my Canadian hesitance to seek medical help when in doubt.

The QEH is not a charity hospital, it is our only choice for immediate medical attention. Expect more, even though the littany of expectation reducing shortages has most of us convinced there is very little health care to go around. If we deny ourselves medical service is that admirable or foolish?

Going to the doctor when you think you are sick is not wrong Canadians! Go ahead, place a burden on the healthcare system that is what it is there for!

I gladly pay for your ‘unnecessary visit’, and for the jello & ice cream for patient x, and the prenatal class for expectant mother y.

I gladly pay for health care! Now, when it comes to Polar Food — those taxes went to waste.

New Study Suggests that Clinical Guidelines Used to Treat Infants with Fevers May Not Improve Outcomes

Press Release Date: March 9, 2004

Experienced pediatricians who relied on their clinical judgment more than existing clinical guidelines were able to minimize hospitalizations and avoid unnecessary lab testing for infants with fevers without a negative impact on the outcomes of care, according to a new study supported by the Agency for Healthcare Research and Quality. The study, “Management and Outcomes of Care of Fever in Early Infancy,” is published in the March 10 issue of the Journal of the American Medical Association.

Underlying conditions associated with fever symptoms in infants are difficult to recognize and range from minor illnesses to those that are life threatening. Expensive strategies that include hospitalization, extensive laboratory testing and intravenous antibiotics have traditionally been used for diagnosis and treatment of infants with fever to protect against bacterial meningitis and bacterial blood infections, illnesses that affect approximately 2 to 3 percent of infants with fevers.

Researchers, led by University of California, San Francisco’s Robert H. Pantell, M.D., worked with more than 573 clinician’s offices in 44 states that were part of the American Academy of Pediatrics’ Pediatric Research in Office Settings Network from 1995 to 1998. The more than 3,000 infants in the study were 3 months or younger and had no health problems other than a fever of at least 100.4

One of my baby books says that fever in itself causes no damage. So I was probably wrong (though my take was current wisdom until recently). In the old days nobody knew why people died. That’s why people always died of fever and why there were so many attempts to bring fever down. Fever was usually the main symptom (something noticeable that could be cited) of their illness. Now that few of us die of the kind of illnesses that cause fevers, fever seems less threatening. But that doesn’t mean you should be complacent. You should still see a doctor when your baby has a high fever. My book says: at 105 for a toddler. If you’re worried go anyway. Fever is a sign. Your child may be fighting some infection.

Given meningitis can look like a bad flu, I have little concern about government budgeting before I take my child to get care — misallocation is their problem…if not their credo. I pay for this through my taxes. [Come to think of it, I think I pay my share of 40% of PEI’s, too, so have that visit on me.] I seem to recall that in the good old days of stubbies in Nova Scotia the beer cases said something to the effect of “price includes health tax” (as well as “union made”) rather than “sales tax”. We should be proud of the health system not daunted by it.

If they have good triage, then you’ll know when you are making an unnecessary visit, because you’ll be made to wait and the doctor will recommend against lab tests. There’s no reason to have medical workers standing around twiddling their thumbs and it’s the hospital’s job to make sure you don’t get anybody killed by bringing your child in for a check-up.

In my experience I’ve never been “triaged out” nor have I seen this happen to anyone else. The basic workflow seems to be registration at the desk, wait in the waiting room, see the nurse (who takes blood pressure and temperature and the details of what ails you), wait in the waiting room again, see a doctor. It seems as though the “you’re wasting our time” only comes from the doctor if it happens at all.

That all said, when I’m at emergency, I’m always either sick or with someone I love who is sick, so I can’t claim my powers of observation are at 100%.

British Columbia has a Nurse line. It’s a 1-800 number that is available 24 hours a day. I have phoned this service many times especially when we were unsure if we should go to emergency or not. Last toddler-fever I talked to the nurse for at least 20 minutes before we decided not to take said-toddler to emergency. Do you have anything like that in PEI? I know Ontario does. It is such a great service.